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Type 1 Symptoms & diagnosis

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warspite014

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14
Hello all.

Can anybody tell me what tests are done by GP's for Type 1 diabetes? I would also like to know the different symptoms in Type 1 & Type 2 as all the info I have read all the symptoms seem to be the same!

Any info/advice appreciated.

Thankyou.
 
With younger type1s the onset is usually very rapid. Increased thirst, urination, fatigue and weight loss often followed swiftly by DKA( diabetic ketoacidosis.)This causes symtoms such as:

Vomiting
Loss of appetite
Confusion
Abdominal pain
Shortness of breath
Increased heart rate
Low blood pressure
Increased rate of breathing
Sometimes a distinctive fruity odor on the breath (ketoens)
In the worst scenario it leads to coma.

With adults as the onset can be much slower, and the initial symptoms similar to those of type 2 many are wrongly diagnosed with type 2 and only get diagnosed correctly when oral medications don't work. Sometimes they are not diagnosed until they end up with DKA.
I've observed (from reading forum posts )that most people in this situation seem to report unexplained rapid weight loss coupled with very high fasting blood glucose.

The possible tests to distinguish are C peptide which shows how much insulin is being produced and various antibody tests ( Glutamic Acid Decarboxylase (GAD) antibody test - tests for
Islet cell antibodies (ICA) and Insulin antibody tests )These may show that there has been an autoimmune 'attack' . However none of these tests are conclusive. Someone who has had type 2 for some time may have little insulin of their own, antibody tests can also be negative at the time of testing even in obvious childhood onset type 1. Diagnosis is done on the whole clinical picture rather than just one test. As insulin is necessary, the sensitivity to insulin is also a factor. I don't think that most GPs in the UK will order those tests.
 
appreciate your time in such a detailed explanation.. thank you. I get the impression that everybody is Type 2 until they become so poorly that further tests are done. I am very concerned due to the fact that my dad died at 57 as did his dad before him. My dad would never talk about his condition.. it was a taboo subject! All we know is that he used to carry a small black "kit" which he hardly used and occassionally recorded info on a little chart.. My GP prescribed Metformin & Ramipril and told me to lose weight. My HbA1c was 7.9%. In 8 weeks I have lost almost 3 stone! I don't think I have done anything too excessive. I have cut out alcohol, sweets, cakes, biscuits and loads of other rubbish and have started walking as much as i can. I hope this explains my weight loss! I have to see my GP again in 2 weeks. I am always thirsty, very tired (diagnosed with sleep apnoea 6 months ago), and always feel sick although never am... i often think perhaps i should speak to somebody other than my GP. Thanks again.
 
i also meant to say that i constantly suffer with cold fingers, nose & toes (i put it down to poor circulation but at 38?) and frequently get pins & needles and numbness in my hands and feet. I also have very itchy arms and feet (i self diagnosed athlete's foot) and skin on my hands/fingers seems to contstantly peel... not in a good shape really! I also have a couple of "spots" on my face which never ever go and should i inadvertantly pick them they will bleed for ages.. shaving can be a nightmare!!
 
i don't have my own blood monitor... my GP told me that he isn't initially worried about my blood sugar level but has got to reduce my hba1c... tells me there is a difference between blood sugar level and the % of red blood cells retaining sugar? I hope it's the combination of the medication and diet that causing my problems!
 
warspite014 said:
appreciate your time in such a detailed explanation.. thank you. I get the impression that everybody is Type 2 until they become so poorly that further tests are done.
Click to expand...

Sadly that's often the way they tend to think.

Another metric that may be useful is your full lipid panel: Type 2s with insulin resistance tend to have a pattern of low HDL, high LDL and sky high trigs. Type 1s and other types without IR tend to have a more normal profile.
 
Type 2s with insulin resistance tend to have a pattern of low HDL, high LDL and sky high trigs. Type 1s and other types without IR tend to have a more normal profile.Trinkwasser
Click to expand...
I don't think that this is true . In undiagnosed or poorly controlled type 1 the pattern is similar to that of type 2, with high trigs. One source that I can't link to because its a book describes it as a secondary type IV lipid disorder. Type 2 diabetes having 'primary' type IV (Textbook of Biochemistry and Human Biology G. P. Talwar, Talwar & Srivastava (eds.), L. M. Srivastava )
This medscape article also says.
Uncontrolled diabetes mellitus, both type 1 and type 2, is one of the most common causes of hypertriglyceridemia, and it is often severe in patients presenting with ketosis.
Patients with type 1 diabetes mellitus are insulin deficient, and LPL is largely ineffective. Control of these patients' diabetes mellitus with insulin will restore LPL function, reducing triglyceride levels and restoring diabetes mellitus control
Click to expand...
http://emedicine.medscape.com/article/126568-overview

From my own experience, on diagnosis my tests showed opalescent plasma, high LDL and high trigs. Two months later with controlled blood glucose, plasma was straw coloured, LDL farirly lo and trigs very low.

For Warspite it doesn't help distinguish . Though with a family history of early heart disease one would hope that the lipids profile would be tested anyway. It must be extraordinarily difficult for doctors to distinguish between the 2 types, and at least 85% of the time in adults its likely to be type 2 . The see what happens as we try the various possible interventions has the advantage of 'simplicity' . Unfortunately when interventions don't work some doctors seem to feel that its the patients lack of complicity rather than the intervention being the wrong one. (however thats maybe justified in many cases)
Hopefully when you see your doc in 2 weeks you will have another Hb A1c which will show whether your average blood glucose levels are reducing , then your weight loss would be more likely to be because of your diet and exercise. You should tell him about your increased thirst etc and your worries.
 
Go back and ask for - no demand- the tests to determine insulin resistance or lack of insulin production as I did (viewtopic.php?f=1&t=7734&start=75#p73662)

It is your health and I get the impression that although there are many resources now put into diabetes not many of them are very clued up yet.
 
HbA1c
warspite014 said:
i don't have my own blood monitor... my GP told me that he isn't initially worried about my blood sugar level but has got to reduce my hba1c... tells me there is a difference between blood sugar level and the % of red blood cells retaining sugar? I hope it's the combination of the medication and diet that causing my problems!
Click to expand...

HBa1c (red blood cell sugar) is an average over the past 6-8 weeks, typically done every 3 months or so. Whereas the fingerprick tests done with a portable meter show what your blood sugar is right now. Ideally you need both, because HbA1c cannot tell you how a particular food or activity affects your blood sugar, or whether your sugar is too low or just feels that way because your body has got used to it being very high and now it's come down to the normal range. Unfortunately, HbA1c every 3 months is cheaper than lots of home testing, hence GPs tend to say home testing is not necessary unless you're injecting insulin. A bit like giving you a car to drive on a road with a speed limit, with no speedometer, just something that works out the average speed over the past 2 months!!!
 
This is all very interesting and it's so good of all of you to go into such detail... I will speak to my GP as I am concerned. From what I read here and elsewhere the chances of being Type 1 are very slim... however i am more concerned now that after speaking to mom again it seems that dad was supposed to check his levels and he did have insulin to inject but didn't!!! I am now slightly more confused because i now know 2 people who inject insulin but have been diagnosed Type 2!!??
 
There are many T2's who inject Insulin. A lot of GP's consider it the first and best treatment ?
Me personally - I avoid it. There are other alternatives usually.

Ken.
 
Warspite,

Injecting insulin doesn't mean someone is a Type 1. The types have different causes, but all end up with blood sugar being raised. A type 2 who goes onto insulin hasn't "become type 1". Some adults who develop T1 are initially misdiagnosed as T2 and only later get properly clarified as T1 - but they haven't changed their type, it was the label that was wrong. It's like saying someone has a cold, then finding out its hayfever - the illness hasn't changed, the symptoms are similar, but depending on the true diagnosis they may need completely different treatments.

Some type 2s can manage efectively with appropriate diet/lifestyle, some may need that plus tablets, others will need insulin. A true type 1 though will always need to take insulin, even if very active and eating no carbohydrate at all. There are other variations (LADA, MODY etc), but its most important first to get clear in your head about types 1 and 2.

Don't worry about getting confused - even some doctors simply label anyone on insulin as type 1!
 
I think I understand the difference between T1 & T2. The bit I don't get is if the symptoms are the same how does your GP diagnose which Type you are? I have been really concerned since being diagnosed "diabetic" and the more i think about it and the more i read the more concerned i get! During the last few days I have felt really poorly. I have had a mad thirst and been itching all over which is a little embarrasing when i'm sitting at my desk at work having a good old scratch!! I have felt really nauseous which has been very uncomfortable. My feet are also becoming alot worse .. itching etc (athletes foot cream doesn't help!). I went to see my GP with my concerns today. He said that they are side affects of diabetes and shouldn't worry. I have an appointment in 2 weeks time to have further blood tests done. He made a comment about my concerns in my notes.. which doesn't really help! I feel I have to talk about these worries and concerns but obviously by GP is not the person. I guess there is only so much you can talk about during your 3 minute appointment! Who else could I talk to? Can I get tests done to get a specific diagnosis?
 
i am sitting in the office as i type... my arms are itching, my legs are itching, my feet are itching, my head is itching. I have freezing cold fingers and toes and i feel very sick. It is a very unpleasant situation to be in. i can't continue like this!
 
you need a blood monitor to check your blood, if it is high you will feel unwell,get testing and let us know what it is and then we may be able to help :D
 
Re: test meter
i bought mine 2 days ago from Boots they have the Accu-check aviva on half price at £7.63 and the strips on half price at £3.24 for 10
 
Thanks very much. Sorry I don't reply sooner but you have probably realised that i am on night shifts this week and as such do my best to sleep in the day... (unsuccessfully!!).. i am off to get a meter tomorrow and try and get some answers as to why i am feeling so unwell. Some good news i would like to share... today i have weighed in at 15.0 st... first target met. 8 weeks ago i was 17.10 st... let's hope the weight loss is due to my new diet and excercise regime!! The GP didn't seem to concerned. Thanks all again. I'll keep you updated.
 
well done with the weight loss, let us know when youve tested :D
 
phoenix said:
Type 2s with insulin resistance tend to have a pattern of low HDL, high LDL and sky high trigs. Type 1s and other types without IR tend to have a more normal profile.Trinkwasser
Click to expand...
I don't think that this is true . In undiagnosed or poorly controlled type 1 the pattern is similar to that of type 2, with high trigs. One source that I can't link to because its a book describes it as a secondary type IV lipid disorder. Type 2 diabetes having 'primary' type IV (Textbook of Biochemistry and Human Biology G. P. Talwar, Talwar & Srivastava (eds.), L. M. Srivastava )
Click to expand...

Yes I partly agree! The big difference is that in Type 2 the dyslipidemia may precede the diabetes *diagnosis* by years, and since it is as they say a factor of "uncontrolled" diabetes it may not last very long in a Type 1. High BG in itself can induce IR even in Type 1s without the genetic precursors (so can things like hypothyroid) but in general most of you Type 1s have lipids that many Type 2s can only dream about
 
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